โรคไตเรื้อรัง 2552

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.. 2552ISBN 974-300-791-0 1 25525,000 2 50 3 47 103100-2716-6901 () (Chronic Kidney Disease, CKD) (EndStageRenalDisease,ESRD) 12 2552III 2552IV7 .. 25528911121314 1:15 2: 17 3:20 4:21 5:22 6:24 7:25V8:289:29 10:30 11:34 12:35 13:36 14:37 15:38 16:39 17:40143244 12 25523 (eGFR)45 MDRD 4 (eGFR)46 MDRD IV .. 255278 a (cost effective) + c b Strength of Recommendation9 .. 2552Quality of Evidence 1 1.1 (systematic review) - (randomize-controlled clinical trial) 1 1.2 - (awell-designedrandomize-controlledclinical trial) 1 2 2.1(non-randomizedcontrolledclinical trial) 2.2 (well-designednon-randomizedcontrolled clinical trial) 2.3 (cohort) (case-controlanalyticalstudies) / 102.4(multipletimeseries) ..2480 3 3.1 (descriptive studies) 3.2 (fair-designed controlled clinical trial) 4 4.1 (consensus) 4.2(caseseries)2 (anecdotal report) 11 .. 2552 1. (screening and consultationor referral) 2.(slowingtheprogressionofkidneydisease) 3.(evaluationandtreatingCKDcomplications) 4. (cardiovascu-larriskreduction) 5.(preparationforrenalreplacementtherapy)121.3(glomerularltrationrate,GFR) 1.12 3 1.1.1 1.1.1.1 microalbuminuria 1.1.1.2 proteinuria 500 mg 500 mg/g creatinine1.1.2 (hematuria) 1.2 1.32.GFR60mL/min/1.73m2 3 13 .. 25521 GFR 902 GFR 60 - 893GFR 30 - 594GFR 15 - 295 < 15 () GFR (mL/min/1.73m2)14 : 2.2 ( 18) microproteinuriaalbuminuriatotal 24 < 300 mg-> 300 mgprotein- (dipstick)< 200 mg/g-> 200 mg/g creatininecreatinine protein/ creatinine ratioalbumin 24 < 30 mg30-300 mg> 300 mg-(microalbuminuriadipstick)< 30 mg/g30-300> 300 mg/g creatininemg/gcreatinine albumin/creatinine creatinine ratio15 .. 2552 1 1.1( a 1)1.2( a 2)1.3 (autoimmune diseases) ( + 3)1.4 (systemic infection) ( + 3)1.5 (cardiovascular disease)( + 3)1.6( + 3)161.7( + 4)1.8 60 ( + 4)1.9 ( + 4)1.10( + 4)1.11( + 4)17 .. 2552 21 2.1estimatedGFR(eGFR)1(serumcreatinine,SCr) Modication of Diet in Renal Disease (MDRD)Equation[1]( a 2)eGFR (mL/min/1.73m2) =186.3 x SCr (jae) 1.154 x Age 0.203 x (0.742 ) MDRDequation eGFR Crockcoft-Gault equation( c 4)[2]1.73m2 CCr (ml/min) =(140Age) x Body weightx (0.85 ) 72 x SCr[1] racial-factor eGFR racial-factor1.016 MDRD [2] Body surface area (Mosteller formula) = Body weight (kg) x Hight (cm) 3,600182.2 (Dipstick)2.2.12.2.1.11+ ( a 3)2.2.1.2 urinaryalbumin/creatinineratio (UACR)(spotmorningurine)30-300mg/g microalbuminuria( a 2)2.2.1.3UACRmicroalbuminuriadipstickmicroalbuminuria( + 4)2.2.22.2.2.12+ 19 .. 25522.2.2.2 1+ urinaryprotein/creatinineratio (UPCR)500mg/g( a 3)2.3 microscopic examination 5/HPF ( a 4)2.4 2.1 - 2.33( a 4) 2.5(plainKUB)/(ultrasonographyofKUB)( c 4)20 3eGFR ( a 4)3.1 1 2 12 ( 6 )3.2 3 6 (12) 3.3 4 3 ( 6 )3.4 5 3 21 .. 2552 44.1 4.1.1 eGFR 30-59 mL/min/1.73m2 7 mL/min/1.73m2 ( a 4)4.2 4.2.1 eGFR 30-59 mL/min/1.73m2 7 mL/min/1.73m2 ( a 4)4.2.2 eGFR 30 mL/min/1.73m2( a 4)4.2.3 1,000 mg spoturineprotein/creatinineratio1,000mg/gcreatinine( c 4)22 5 5.1 130/80 mmHg( a 1)5.2angiotensinconverting enzyme inhibitor (ACEI) angiotensin recep-tor blocker (ARB) ( a 1)5.3ACEIARB ( a 1)5.4ACEIARB (SCr) (serum K)[3] SCr 30%4serumK 5.5 mmol/L( a 3) 23 .. 25525.5 2 ( a 2)[3] ,GFR ACEI ARB (.) 120110 - 119< 110GFR (mL/min/1.73m2) 6030 -595 4-12 2-4 < 2 BP 6-12 3-6 1-3 24 66.1(proteinuria) UPCR 500-1,000 mg/g creatinine( + 2) 6.2(proteinuria) ( + 2)6.3ACEIARB( + 2)6.4 ACEI ARB( c 1, 2) ( + 4)25 .. 2552 77.1 7.1.1(Preprandialcapillaryplasmaglucose)90-130 mg/dL (5.0-7.2 mmol/L)( + 2)7.1.2(Peakpostprandialcapil-laryplasmaglucose)180mg/dL(90>90>90>90>90>900.9>90>90>90> 90>9089861.0>90>9088848179761.1>908479757370681.2827671686664621.3756965626058561.4696360575553521.5635855535149481.6595451494746441.7555148464443411.8514745434140391.9484442403937362.0464240383635342.1434037363433322.2413835343332312.3393634323130292.4373432312929282.5353231292827272.6343129282726252.7323028272625242.8312827262524232.9302726252423223.0282625242322223.1272524232221213.2262423222121203.3262422212020193.4252321202019193.5242221201918183.6232120191818173.7222119191817173.8222019181717163.9211918171716164.0201918171616154.1201817161615154.2191817161515154.3191716161515144.4181716151514144.5181616151414134.6171615141413134.7171615141413134.8171514141313134.9161514131313125.0161514131312125.1151413131212125.2151413131212115.3151413121211115.4141312121111115.5141312121111115.61413121211111046 4 (eGFR) MDRD ( mL/min/1.73m2) ()(mg/dL)203040506070800.6>90>90>90>90>90>90>900.7>90>90>90>90>9088860.8>909084817875730.9857874706866641.0756965626058571.1676258565452511.2615653514947461.3565148464443421.4514744424140381.5474341393836351.6444038363534331.7413835343332311.8383533323130291.9363331302928272.0343129282726252.1322928262625242.2302826252423232.3292625242322222.4272524232221212.5262423222120202.6252322212019192.7242221201919182.8232120191818172.9222019181817163.0211918181716163.1201918171616153.2201817161615153.3191716161515143.4181716151514143.5181615151414133.6171615141413133.7171514141313133.8161514131312123.9161414131212124.0151413131212114.1151413121211114.214131212111111NOTE:NOTE: